高脂血症性重症急性胰腺炎临床特征分析

Clinical Characteristics of Hyperlipidemic Severe Acute Pancreatitis

背景:目前已明确高三酰甘油血症(>11.3 mmol/L)可引起急性胰腺炎(AP)发作或复发。随着代谢综合征发病率的逐年上升,临床上高脂血症性AP病例日益增多。目的:总结高脂血症性重症急性胰腺炎(HL-SAP)的临床特征,提高对该病的认识和诊断水平。方法:收集2000年1月～2011年6月浙江中医药大学附属第一医院确诊HL-SAP和胆源性SAP(BSAP)病例,对其病史资料进行回顾性分析。结果:38例HL-SAP患者和94例BSAP患者纳入研究。HL-SAP组平均年龄显著低于BSAP组[(42.50±13.34)岁对(62.17±16.17)岁,P=0.000];血清三酰甘油水平、胆固醇水平、合并脂肪肝、糖尿病、高血压者的比例以及血清淀粉酶低于3倍正常上限者的比例(52.6%对22.3%)均显著高于BSAP组(P<0.05)。两组间胰腺局部和主要脏器并发症发生情况无明显差异。HL-SAP组血清三酰甘油水平与主要脏器并发症发生数呈正相关(r=0.382,P=0.018)。HL-SAP组出院后复发率显著高于BSAP组(42.1%对11.7%,P=0.000),两组间死亡率无明显差异。结论:本组HL-SAP患者发病年龄偏低,合并代谢综合征组分者比例较高,约半数患者血清淀粉酶正常或升高不显著,AP易复发。

Background： It has been proved that hypertriglyceridemia （ 〉 11.3 mmol/L） may cause acute pancreatitis （AP） episode and recurrent AP. With the increase in incidence of metabolic syndrome, more hyperlipidemic AP was diagnosed in clinical practice. Aims： To summarize the clinical characteristics of hyperlipidemic severe acute pancreatitis （HL-SAP） for improving the understanding and diagnostic performance of this disease. Methods： A retrospective analysis was conducted on HL-SAP and biliary SAP （BSAP） patients admitted from Jan. 2000 to Jun. 2011 at the First Affiliated Hospital of Zhejiang Chinese Medical University. Results： Thirty-eight HL-SAP patients and ninety-four BSAP patients were recruited. The mean age was significantly lower in HL-SAP group than in BSAP group E （42.50±13.34） years vs. （62.17±16.17） years, P=0.000]. The serum levels of triacylglyeerol and cholesterol were significantly higher in HL-SAP group than in BSAP group （P = 0.000）. More cases in HL-SAP group were complicated with fatty liver, diabetes and hypertension when compared with BSAP group （ P 〈 0. 05 ）. Serum amylase lower than three times upper limit of normal was seen in 52.6% cases of HL-SAP group, which was significantly higher than that in BSAP group （22.3%, P =0.001 ）. The incidence of both pancreatic and main organ complications were similar in HL-SAP and BSAP groups. A positive correlation was observed between serum triaeylglycerol level and number of main organ complications in HL-SAP group （r = 0.382, P = 0. 018）. The recurrence rate after discharge was significantly higher in HL-SAP group than in BSAP group （42. 1% vs. 11.7%, P = 0. 000）, while there was no statistical difference in mortality between the two groups. Conclusions： Patients with HL-SAP are significantly younger and most of them are complicated with components of metabolic syndrome. Serum amylase is normal or only minimally elevated in about 50% of the cases. The recurrence rate is considerably higher in IlL-SAP patients.